To the Editor:

“Addressing the Obesity Epidemic: A Genomics Perspective” in your April 2007
(1) issue speaks of the importance of considering all aspects of obesity.
However, one aspect overlooked in the article is weight gain associated
with medical treatment. Many classes of drugs are associated with weight gain
that leads to overweight or obesity; these include atypical antipsychotic drugs,
lithium, some antidepressant drugs, some antiepileptic drugs, and some steroids.
Other drugs are associated with fat redistribution (e.g., some drugs for
HIV/AIDS).

In addition to increasing weight, atypical antipsychotic drugs increase risk
for hyperglycemia (as noted in a black-box label required by the Food and Drug
Administration [FDA]), and they are associated with lipid dysregulation
(2). Atypical antipsychotic drugs induce excitation and hypomania or mania, adverse effects never reported for the older versions of typical antipsychotic drugs
(3). Some atypical antipsychotic drugs are also noncardiac QTc-interval–prolonging drugs and
are associated with increased sudden cardiac death
(4).

Atypical antipsychotic drugs are widely used off-label. The FDA issued a Public Health Advisory warning of a 60% to 70% increased risk for mortality among elderly people with dementia
being treated with atypical antipsychotic medications (5). From 1993 through
2002, prescriptions for atypical antipsychotic drugs for American children
increased 500% (all off-label);
85% of those prescriptions were for nonpsychotic conditions (6). The
public health implications of wide off-label use of this class of drugs merits more study.

Eileen McGinn, MPHStudent
Hunter College of the City University of New York
Brookdale Center for Healthy Aging and Longevity
New York, NY

The opinions expressed by authors contributing to this
journal do not necessarily reflect the opinions of the U.S. Department of Health
and Human Services, the Public Health Service, the Centers for Disease Control and
Prevention, or the authors’ affiliated institutions. Use of trade names is for
identification only and does not imply endorsement by any of the groups named
above.